Revenue Integrity Manager

• Lead and manage Revenue Integrity operations, ensuring accurate charge capture, coding, billing, and reimbursement processes.
  
• Oversee the maintenance and governance of the Charge Description Master (CDM), including code updates, pricing changes, and regulatory compliance. 
  
• Ensure proper mapping of charge codes and billing workflows within the hospital information system.
  
• Develop and implement charge audit, reconciliation, and monitoring processes to identify revenue leakage and improve revenue capture. 
  
• Conduct financial and operational reviews to assess charge capture accuracy and billing completeness. 
  
• Ensure compliance with payer requirements, healthcare regulations, and coding standards including CPT, HCPCS, and DRG methodologies.
  
• Collaborate with clinical, finance, revenue cycle, billing, and insurance departments to improve revenue cycle performance. 
  
• Lead cross-functional initiatives focused on revenue enhancement, operational efficiency, and process improvement. 
  
• Oversee pricing structures and support the preparation of patient and payer cost estimates.
  

Qualifications

• Bachelor's degree in Healthcare Administration, Health Information Management, Finance, Accounting, Business Administration, or a related field.
  
• Master's degree preferred.
  
• Professional certification such as CPC, CCS, RHIA, RHIT, CHFP, or equivalent preferred.
  
• Strong knowledge of healthcare revenue cycle operations, coding compliance, and reimbursement methodologies.
  

Requirements

• Minimum 5-7 years of progressive experience in Revenue Cycle, Revenue Integrity, Patient Financial Services, Healthcare Finance, or related healthcare operations.
  
• Demonstrated experience managing Charge Description Master (CDM) processes and charge capture programs. 
  
• Strong knowledge of CPT, HCPCS, DRG, revenue codes, and payer reimbursement methodologies.
  
• Experience with healthcare information systems, preferably Cerner or equivalent electronic health record and billing platforms. 
  
• Excellent analytical, auditing, and problem-solving skills.
  
• Strong leadership and stakeholder management capabilities.
  
• Ability to lead multidisciplinary teams and drive process improvement initiatives.
  
• Excellent communication and presentation skills.